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Independents' Day

Violent patients should be 'exiled' from practices

Violent patients cause major headaches for their GPs. The only unaffected persons seem to be the troublemakers themselves.

There has been a lame attempt of a 'traffic light' policy that implies it's fine to hit your doctor once as long as you don't do it a second or third time. The zero-tolerance policy has so far proven to be a rather hollow phrase with little impact.

As even children have to learn to live with the consequences of their actions, I can't understand why adult violent patients should not.

At present you might be struck off your GP's list if you punch somebody at the surgery, but you are guaranteed another doctor to fill the gap without having to do much about it.

My suggestion would be the automatic removal from the list of a patient who has been violent to any of the staff or doctors.

There should be no forced reallocation to another list but the patient would have forfeit his or her right to their own GP and would have from then on to attend A&E of one local specially designated hospital.

These departments should be ordinary 'working' casualties and not have to cater solely for violent patients, though they should get generous extra funds to have dedicated GPs and enough other staff and equipment to be able to deal with potentially violent people.

There should also be a quick and easy connection to the nearest police station.

In an A&E environment staff are not as isolated as in a GP surgery and it would be easier to train everybody regularly in self-defence as well as to have state-of-the-art surveillance equipment in waiting rooms and corridors.

In this way these patients might have to wait each time for a few hours to be seen for their sore throats and will have to travel further in order to get medical attention, but maybe the message will get through.

After two or three years of such 'exile' the patient may apply to register with a GP again, but it should be fully to the new GP's discretion to accept such a patient and there should be no automatic right to an own GP in such a case. The new GP should have all the details as to why the patient lost his last doctor before accepting him or her on to the list. Here a cash incentive to take on an ex-violent patient might be appropriate. Should there be a relapse in violence the same procedure as above should apply, this time maybe with a five- or 10-year ban.

These suggestions seem harsh, but only if we keep measuring ourselves differently to our patients. Nobody would think twice about striking off a doctor who would punch a patient or his staff.

Being struck off by the GMC is a far harsher treatment than merely being struck off a GP's list.

Dr Brita O'Dolan



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